Abstracts

Despite access to neurological treatment, children with epilepsy have unmet mental health needs (Ott et al., 2003). This discrepancy in care is significant because quality of life for these children is poor (Austin [amp] Dunn, 2000; Sabaz et al., 2003) and psychopathology is frequent (Austin et al., 2001; Caplan et al. in press; Dunn et al., 1999). Prior findings on pediatric epilepsy and chronic illness suggest that differences in provider and parent perceptions about the mental health problems of these children underlie poor access to mental health care (Cadman et al., 1987; Coulter [amp] Koester, 1985). This study examined provider knowledge, attitudes, and beliefs about co-morbid mental health problems, perceived barriers to mental health care, and parental concerns in pediatric epilepsy. We examined potential barriers to mental health care in peditric epilepsy by comparing knowledge, attitudes, and management practices in two primary care provider groups. Pediatric neurologists (n=18) and pediatricians (n=18) completed a 39-item questionnaire before and after a lecture on psychopathology in pediatric epilepsy. Questions included psychosocial aspects, provider caseload, potential barriers to mental health assessment and treatment, parental concerns, and stigma of epilepsy. Knowledge of psychosocial aspects of epilepsy (p[lt].0001) and comfort prescribing stimulants (p=.03) increased significantly across groups after the talk. Before the lecture both groups rated seizure control as the most important parental concern but having no behavioral and learning difficulties after the lecture (p[lt].0001). At baseline although both groups felt they lacked training to do behavioral assessments, after the talk they felt more confident conducting these assessments (p[lt].05) and making mental health referrals (p[lt].01). Compared to pediatricians, pediatric neurologists were more aware of cognitive effects of antiepileptic drugs (p[lt].03), felt adequately trained to assess and treat behavioral problems (p[lt].03), and benefited more from mental health practitioner feedback (p=.05). As predicted, the lecture provided no significant change in provider management practices. Providers emphasize the relevance of seizures rather than psychosocial issues for quality of life in pediatric epilepsy. Knowledge about the impact of epilepsy on behavior and learning helps physicians understand parents[rsquo] main concerns, importance of common co-morbid mental health and learning problems, and the need for mental health referrals in these children. (Supported by Epilepsy Foundation of America: Shire Targeted Award)